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Making "that" decision

14 Mar 09:00 by Georgie Cheeseman

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This post was first published on ' The Ramblings of a Graduate Paramedic' Blog by Saul Gaunt. You can follow him on Twitter @saulie1 

Yesterday, I “ran” my first resuscitation as a student paramedic. A relatively normal situation for a paramedic to be in, a daily occurrence if you like. It was however my first time. I had a patient awake and responding to me, before then going into cardiac arrest. “Good afternoon, I said to the patient, how you feeling” the normal pleasantries were exchanged and within a minute of meeting this gentleman, I was jumping up and down on his chest and began the administering the life saving protocol I had drilled into me since day one. 57 mins later, this gentleman was intubated, cannulated, had 9 rounds of adrenaline, and had certainly had his ribs broken in the process of CPR.

I was running the show though, it felt good to know that after three years I was getting somewhere, somewhere with my confidence levels, my ability to delegate and my ability stay calm. However, as I gave the order to switch the person performing CPR and to give the ninth dose of adrenaline. It struck a chord with me. 57 mins of jumping up and down on this patient's chest, for what reason anymore. There had been no output throughout, no ounce of response from this patient. For the first time since beginning my training I began the process of “stopping CPR”. For me this didn’t sit comfortably during the process of resuscitation you just sort of run on autopilot. But having time to reflect you realise the enormity of the decision you are making. I’m 22 and I am about to make the decision that this patient is no longer going to receive the resuscitation treatment that is keeping him alive. A patient that I had a connection to, a person that an hour a go was alive and talking to me. I felt myself becoming angry that he wasn’t going to survive.

On paper, he had such a good chance of survival, good chest compressions the moment he went down, intubated (tube down his throat to assist with his breathing) and cannulated (needle in his hand to administer drugs) within mins of this, but patients aren’t like textbooks, and now I had to make the decision to stop. I called for a review of what we had been doing. Going head to toe on the patient, in a way convincing myself that this was the right thing to do. I gave the order to stop CPR and have a final pulse and rhythm check, of which still nothing.

That was it…

The patient was life extinct, we all agreed to stop resuscitating the patient. I began performing my own little post-life routine, that I have created. Trying to make the patient look “presentable” for the family, however also to take my mind off what has just happened. Keeping myself busy. It wasn’t until after, while filling out the paperwork, that it suddenly hit me, what had happened, I had just made the decision to stop resuscitation, to stop attempting to save this man’s life. It was something that I have been contemplating since it happened, something that I am assured will become easier with experience. But now it reminds me how short life is, and how we have to live every day to the fullest, and treat everyone you meet as if you won’t meet them again. After I completed the paperwork, everyone congratulated me on how well I and performed.

But this did not have the same effect it usually does on me. I felt I had failed, failed this patient and his family, it didn’t quite hit me until I arrived back home that evening, where the anger set in. Why didn’t he survive I asked myself, self-destructive thoughts of could I have done anything better. Did I make the right decision to halt CPR. Of course the answer was that I did everything I could, he died because he died, nothing to do with my actions. But it took a long time to discover this. My mentor always used to say take home something from every patient, initially for me this was a sense of anger and dread towards my actions and the outcome, however this turned to a lease of life, wanting to live my life to the fullest, and to treat everyone I meet as if it's the last time.